How to improve our clinical interviews

Abstract

This paper, in the first place underlines the fact that the quality of our interviews is not as adequate as it should be: we interrupt the patient 18 seconds after he has started to speak (Toronto Consensus); in half the cases the doctor and the patient are not in agreement about the nature of the problem, etc. On the other hand, we underline certain advantages of improving clinical interview skills, such as an increase in patient satisfaction, a decrease in clinical consultations, an improvement of diagnostic precision and a change of habits. We provide some general ideas for improving our clinical interviews and we propose the semi-structured clinical interview, introduced by Borrell, as a model of improvement. This is divided into an exploratory phase in which, following a cordial greeting, we spell out the real reason for the consultation and we explore the beliefs and expectations of the patient; to this end we use different techniques, above all support for the patient's narration. The subsequent phase is the phase of resolution, with a first informative part, which rests above all with the professional and is based on techniques of giving information in an adequate manner, and a second part involving negotiation; this is obligatory whenever the patient has doubts about our orientations. It involves an exchange of opinions and a reconversion of ideas until final agreements are achieved.